Hypofractionated volumetric modulated arc therapy in ductal carcinoma in situ: Toxicity and cosmetic outcome from a prospective series

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Abstract

Objective: Hypofractionated radiotherapy in early stage breast cancer is an effective adjuvant treatment, but there is a lack of randomized data for patients with ductal carcinoma in situ (DCIS). The aim of this study is the evaluation of skin toxicity and cosmesis, and early clinical outcome of DCIS patients enrolled in an institutional Phase II trial of hypofractionated breast irradiation. Methods: 137 DCIS patients were enrolled in the trial. All patients underwent volumetric modulated arc therapy (VMAT) to the whole breast with a total dose of 40.5 Gy in 15 fractions over 3 weeks, without tumour bed boost. Acute and late skin toxicities were recorded. Cosmetic outcomes were assessed as excellent/good or fair/poor. Early clinical outcome was reported. Results: Median age was 58 y.o. (range 30-86). The median follow-up time was 22 months (range 6-45). At the end of the radiotherapy, skin toxicity was grade G1 in 56% of the patients, G2 in 15%, no patients presented G3 toxicity. In the range of 3-9 months of follow-up, the skin toxicity was G1 in 28% of patients, no G2-G3 cases; cosmetic outcome was good/excellent in 95% of patients. In the follow-up interval of 9-24 months, the skin toxicity was G1 in 12% of patients, no G2-G3 toxicity; cosmetic outcome was good/excellent in 96% of patients. After an early evaluation of clinical outcomes, 5 patients (3.6%) presented an in-breast recurrence. Conclusion: Hypofractionated radiotherapy using VMAT is a viable option for DCIS. A longer follow-up is needed to assess clinical outcomes and late toxicity. Advances in knowledge: The use of hypofractionated VMAT is dosimetrically feasible for treating breast DCIS.

Original languageEnglish
Article number20170634
JournalBritish Journal of Radiology
Volume91
Issue number1085
DOIs
Publication statusPublished - Jan 1 2018

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Intensity-Modulated Radiotherapy
Carcinoma, Intraductal, Noninfiltrating
Cosmetics
Skin
Breast
Radiotherapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{ceb881a47e524689b93369939069c638,
title = "Hypofractionated volumetric modulated arc therapy in ductal carcinoma in situ: Toxicity and cosmetic outcome from a prospective series",
abstract = "Objective: Hypofractionated radiotherapy in early stage breast cancer is an effective adjuvant treatment, but there is a lack of randomized data for patients with ductal carcinoma in situ (DCIS). The aim of this study is the evaluation of skin toxicity and cosmesis, and early clinical outcome of DCIS patients enrolled in an institutional Phase II trial of hypofractionated breast irradiation. Methods: 137 DCIS patients were enrolled in the trial. All patients underwent volumetric modulated arc therapy (VMAT) to the whole breast with a total dose of 40.5 Gy in 15 fractions over 3 weeks, without tumour bed boost. Acute and late skin toxicities were recorded. Cosmetic outcomes were assessed as excellent/good or fair/poor. Early clinical outcome was reported. Results: Median age was 58 y.o. (range 30-86). The median follow-up time was 22 months (range 6-45). At the end of the radiotherapy, skin toxicity was grade G1 in 56{\%} of the patients, G2 in 15{\%}, no patients presented G3 toxicity. In the range of 3-9 months of follow-up, the skin toxicity was G1 in 28{\%} of patients, no G2-G3 cases; cosmetic outcome was good/excellent in 95{\%} of patients. In the follow-up interval of 9-24 months, the skin toxicity was G1 in 12{\%} of patients, no G2-G3 toxicity; cosmetic outcome was good/excellent in 96{\%} of patients. After an early evaluation of clinical outcomes, 5 patients (3.6{\%}) presented an in-breast recurrence. Conclusion: Hypofractionated radiotherapy using VMAT is a viable option for DCIS. A longer follow-up is needed to assess clinical outcomes and late toxicity. Advances in knowledge: The use of hypofractionated VMAT is dosimetrically feasible for treating breast DCIS.",
author = "{De Rose}, Fiorenza and Antonella Fogliata and Davide Franceschini and Cristina Iftode and Rosalba Torrisi and Giovanna Masci and Andrea Sagona and Corrado Tinterri and Alberto Testori and Wolfgang Gatzemeier and Bethania Fernandes and Daoud Rahal and Luca Cozzi and Armando Santoro and Marta Scorsetti",
year = "2018",
month = "1",
day = "1",
doi = "10.1259/bjr.20170634",
language = "English",
volume = "91",
journal = "British Journal of Radiology",
issn = "0007-1285",
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number = "1085",

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TY - JOUR

T1 - Hypofractionated volumetric modulated arc therapy in ductal carcinoma in situ

T2 - Toxicity and cosmetic outcome from a prospective series

AU - De Rose, Fiorenza

AU - Fogliata, Antonella

AU - Franceschini, Davide

AU - Iftode, Cristina

AU - Torrisi, Rosalba

AU - Masci, Giovanna

AU - Sagona, Andrea

AU - Tinterri, Corrado

AU - Testori, Alberto

AU - Gatzemeier, Wolfgang

AU - Fernandes, Bethania

AU - Rahal, Daoud

AU - Cozzi, Luca

AU - Santoro, Armando

AU - Scorsetti, Marta

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Hypofractionated radiotherapy in early stage breast cancer is an effective adjuvant treatment, but there is a lack of randomized data for patients with ductal carcinoma in situ (DCIS). The aim of this study is the evaluation of skin toxicity and cosmesis, and early clinical outcome of DCIS patients enrolled in an institutional Phase II trial of hypofractionated breast irradiation. Methods: 137 DCIS patients were enrolled in the trial. All patients underwent volumetric modulated arc therapy (VMAT) to the whole breast with a total dose of 40.5 Gy in 15 fractions over 3 weeks, without tumour bed boost. Acute and late skin toxicities were recorded. Cosmetic outcomes were assessed as excellent/good or fair/poor. Early clinical outcome was reported. Results: Median age was 58 y.o. (range 30-86). The median follow-up time was 22 months (range 6-45). At the end of the radiotherapy, skin toxicity was grade G1 in 56% of the patients, G2 in 15%, no patients presented G3 toxicity. In the range of 3-9 months of follow-up, the skin toxicity was G1 in 28% of patients, no G2-G3 cases; cosmetic outcome was good/excellent in 95% of patients. In the follow-up interval of 9-24 months, the skin toxicity was G1 in 12% of patients, no G2-G3 toxicity; cosmetic outcome was good/excellent in 96% of patients. After an early evaluation of clinical outcomes, 5 patients (3.6%) presented an in-breast recurrence. Conclusion: Hypofractionated radiotherapy using VMAT is a viable option for DCIS. A longer follow-up is needed to assess clinical outcomes and late toxicity. Advances in knowledge: The use of hypofractionated VMAT is dosimetrically feasible for treating breast DCIS.

AB - Objective: Hypofractionated radiotherapy in early stage breast cancer is an effective adjuvant treatment, but there is a lack of randomized data for patients with ductal carcinoma in situ (DCIS). The aim of this study is the evaluation of skin toxicity and cosmesis, and early clinical outcome of DCIS patients enrolled in an institutional Phase II trial of hypofractionated breast irradiation. Methods: 137 DCIS patients were enrolled in the trial. All patients underwent volumetric modulated arc therapy (VMAT) to the whole breast with a total dose of 40.5 Gy in 15 fractions over 3 weeks, without tumour bed boost. Acute and late skin toxicities were recorded. Cosmetic outcomes were assessed as excellent/good or fair/poor. Early clinical outcome was reported. Results: Median age was 58 y.o. (range 30-86). The median follow-up time was 22 months (range 6-45). At the end of the radiotherapy, skin toxicity was grade G1 in 56% of the patients, G2 in 15%, no patients presented G3 toxicity. In the range of 3-9 months of follow-up, the skin toxicity was G1 in 28% of patients, no G2-G3 cases; cosmetic outcome was good/excellent in 95% of patients. In the follow-up interval of 9-24 months, the skin toxicity was G1 in 12% of patients, no G2-G3 toxicity; cosmetic outcome was good/excellent in 96% of patients. After an early evaluation of clinical outcomes, 5 patients (3.6%) presented an in-breast recurrence. Conclusion: Hypofractionated radiotherapy using VMAT is a viable option for DCIS. A longer follow-up is needed to assess clinical outcomes and late toxicity. Advances in knowledge: The use of hypofractionated VMAT is dosimetrically feasible for treating breast DCIS.

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